Influences on Primary Care Provider Imaging for a Hypothetical Patient with Low Back Pain

Objective: How outside factors affect physician decision making remains an open question of vital importance. We sought to investigate the importance of various influences on physician decision making when clinical guidelines differ from patient preference. Methods: An online survey asking 469 primary care providers (PCPs) across four practice sites whether they would order magnetic resonance imaging for a patient with uncomplicated back...

Demographic and Practice Characteristics of Physicians Who Care for Medically Underserved People: A National Survey

Objectives: Few national studies have examined the influence of role models as a potential predictor for caring for medically underserved (MUS) patients. This study tested associations between previous physician role model exposure and caring for MUS populations, as well as examines the practice environments of these physicians. Methods: Between October and December 2011, we mailed a confidential questionnaire to a representative sample of...

Uremic Pericarditis: Distinguishing Features in a Now-Uncommon Clinical Syndrome

We present the case of a 47-year-old man with a history of diabetes mellitus and diabetic nephropathy who was admitted to our hospital with acute uremic myopericarditis. Echocardiography demonstrated a fibrinous pericardial effusion. The patient was initiated on hemodialysis for hyperkalemia, metabolic acidosis, and uremia. He subsequently developed shock from cardiac tamponade, which required emergent pericardiocentesis. He was notably without...

Prevalence and Impact of Diabetes Mellitus on the Frozen Shoulder

Objectives: The objective of this study was to estimate the prevalence of undiagnosed diabetes mellitus in patients with newly diagnosed frozen shoulder (FS) and study whether diabetes mellitus increases the severity of FS disease. Methods: Patients with newly diagnosed FS were consecutively included in this case-control study. Patients who were not already diagnosed as having diabetes mellitus were invited to be tested with the hemoglobin...

Role of Rifaximin in Spontaneous Bacterial Peritonitis Prevention

Cirrhosis affects millions of people around the world and is associated with increased morbidity and mortality. Spontaneous bacterial peritonitis (SBP) is a common complication of liver disease with cirrhosis and accounts for up to 30% of infections in patients with cirrhosis. Patients with a history of SBP and those deemed to be at high risk often are prescribed antibiotics to reduce the incidence of SBP. Fluoroquinolones and...

Late-Stage Melanoma: Be Sure to Screen Uninsured, Unmarried Men

Objective: The purpose of this study was to assess for any associations between individual and social factors and late-stage melanoma in Kentucky from 1995 to 2013. Methods: The study combines three datasets: individual-level data from the Kentucky Cancer Registry, census tract–level data from the US Census, and county-level physician licensure data from the Kentucky Department for Public Health. The study population is described by all...

Group Battlefield Acupuncture in Primary Care for Veterans with Pain

Objective: To obtain preliminary data on the short- and intermediate-term effects of battlefield acupuncture (BFA) on self-reported pain intensity in a relatively large cohort of veterans to assess whether a more comprehensive clinical trial evaluation is warranted. Methods: The treatment, in an outpatient group setting, consisted of up to five auricular semipermanent needles inserted into each ear at prespecified points. Efficacy of...

Mobile Health (mHealth) Use or Non-Use by Residents of West Virginia

Objective: To compare mobile health (mHealth) usage by residents of West Virginia with national estimates. Methods: Pew Research Center data from its Internet and American Life Project were accessed for secondary data analysis. These data, available to the public, are a probability sample of Internet use in the United States, differences in use based on selected variables (eg, education, household income), and how usage affects the lives of...

Risk, Outcomes, and Predictors of Clostridium difficile Infection in Lymphoma: A Nationwide Study

Objective: The risk of Clostridium difficile infection (CDI) has not been well studied in patients with lymphoma. We thus sought to determine the risk of CDI in hospitalizations with lymphoma along with its trend, outcomes, and predictors using a large database. Methods: Hospital discharge data from the Nationwide Inpatient Sample (NIS) from 2007 to 2011 were used for the study. Using the International Classification of Diseases, Ninth...

Uric Acid Control in Advanced Chronic Kidney Disease in a Southeastern US Urban Cohort

Objectives: Uric acid (UA) control may be insufficient in chronic kidney disease (CKD) patients in the current era. It is unclear, however, whether this is the result of environmental effects, patient anthropometrics or insufficient dosing of medical therapy (allopurinol). Methods: We have collected data on multiple clinical and laboratory parameters of 114 CKD clinic patients attending the nephrology clinic of the University of Mississippi...

OPEN ACCESS: Association Between System Factors and Acute Myocardial Infarction Mortality

Objectives: We conducted a cross-sectional study to assess the association between healthcare system factors and death from acute myocardial infarction (AMI), in terms of access (distance to the hospital, mode of transportation), availability (emergency medical services, hospitals), and capability (emergency medical services’ 12-lead electrocardiogram capability, continuous percutaneous coronary intervention and cardiothoracic surgical...

Association Between the Frank Sign and Cardiovascular Events

Clinicians have attempted to find early preclinical physical diagnosis signs to detect vascular diseases at the preclinical stage and to prevent clinical deterioration in time. An interesting example of such signs is the Frank sign, which was first described by Dr Sonders T. Frank in 1973. Our goal was to summarize the clinical trials and observational studies that had examined the association between the Frank sign and cardiovascular diseases....

ICD Discussions: Closing the Gap between What We Say and What They Understand

More than 20 million adults worldwide have a diagnosis of heart failure (HF).1 The prevalence in the United States is expected to increase by 46% from 2012 to 2030, resulting in an increase from 5 million to 8 million Americans living with this condition.2 Approximately 50% of people diagnosed as having HF will die within 5 years.1 Implantable cardioverter-defibrillators (ICDs) are considered the standard of care to prevent sudden cardiac death...

OPEN: Effects of Long-Term Combination LT4 and LT3 Therapy for Improving Hypothyroidism and Overall Quality of Life

Objectives: Hypothyroidism results in decreased mood and neurocognition, weight gain, fatigue, and many other undesirable symptoms. The American Association of Clinical Endocrinologists, the American Thyroid Association (ATA), and The Endocrine Society recommend levothyroxine (LT4) monotherapy as the treatment for hypothyroidism; however, after years of monotherapy, some patients continue to experience impaired quality of life. Combination LT4...

Telerheumatology: The VA Experience

Objectives: We sought to characterize the correlation between diagnoses made during telerheumatology and face-to-face visits and to document patients’ satisfaction with telerheumatology visits. Methods: This quality assurance study of the use of telerheumatology evaluated new patients referred to a Veterans Affairs rheumatology clinic. Patients were seen at a community clinic by a nurse practitioner with a rheumatologist participating in...

Evaluation of Renal Function Estimation Formulas Specific to Dynamic Renal Function for Drug Dosing in Critically Ill Patients

Objectives: The study compared estimated creatinine clearance (eCrCl) between the Cockcroft-Gault (CG) equation and the Jelliffe, Chiou, and Brater equations designed for estimation in dynamic renal function and resulting antimicrobial dosing concordance of five antimicrobials (cefepime, meropenem, piperacillin/tazobactam, vancomycin, and fluconazole) commonly used in the intensive care unit (ICU). Methods: Electronic medical records were...

Mortality in Asthma-Chronic Obstructive Pulmonary Disease Overlap in the United States

Objectives: Asthma-chronic obstructive pulmonary disease (COPD) overlap (ACO) is recognized increasingly as a distinct clinical entity and is associated with higher comorbidities compared with patients with asthma and COPD alone. Little is known about the leading causes of death related to ACO in the US general population, however. Our aim was to define the causes of mortality among patients with ACO compared with asthma and COPD in the US...

Minimal Use of Opioids for Pain Relief in an Internal Medicine Department

Objectives: The objective of the study was to determine if pain control was adequate despite our policy of limited opioid use. Methods: In this observational cohort study, we reviewed 300 consecutive patient charts from an internal medicine department. We extracted demographic data, as well as the patients’ primary diagnosis, pain on admission, daily pain evaluations (numerical rating score ), and treatment. Significant pain was defined as...

Clinical Context and Detection of the Murmur of Advanced Aortic Stenosis

Objectives: Auscultation is an important clue to the presence of aortic stenosis (AS). We sought to assess the effect of symptom status, prior knowledge of diagnosis, and other patient factors on murmur detection. Methods: Patients with moderate-to-severe AS by echocardiography at a single center between June 2015 and June 2016 were included. Five consecutive patient encounters (inpatient and outpatient) within 12 months before the...

Provider Variation in Antibiotic Prescribing and Outcomes of Respiratory Tract Infections

Objectives: Inappropriate antibiotic use for respiratory tract infection (RTI) is an ongoing problem linked to the emergence of drug resistance and other adverse effects. Less is known about the prescribing practices of individual physicians or the impact of physician prescribing habits on patient outcomes. We studied the prescribing practices of providers for acute RTIs in an integrated health system, identified patient factors associated with...